Breech Presentation

Question 1

What are the 4 definitions of breech presentation?

Answer 1

1. frank
2. complete
3. footling
4. knee

Question 2

what is a frank breech presentation?

Answer 2

legs are flexed at the hip and extended at the knees with the buttocks presenting

Question 3

what is a complete breech presentation?

Answer 3

hips and knees are flexed and the feet are tucked beside the buttocks with buttocks and feet presenting

Question 4

what is a footling/kneeling breech presentation?

Answer 4

one or both feet or knees are presenting

Question 5

what are risk factors for persistent breech presentation?

Answer 5

• multiple pregnancy
• poluhydramnios or oligohydramnios
• previous breech
• high parity
• uterine abnormalities
• fetal abnormalities
• placental locality

Question 6

what is the expected interval between the birth of the baby’s bottom and the shoulders appearing?

Answer 6

approx 2 mins

Question 7

how long should the baby be left to ‘hang’ once the baby’s trunk has been delivered?

Answer 7

max 30 seconds

Question 8

What can be done for assisting the birth of extending the legs?

Answer 8

popliteal pressure can be applied behind the knee if the legs have not birthed

Question 9

what can be done for correcting positioning of fetal back?

Answer 9

ensure the back remains uppermost, if not, gently rotate the baby by positioning the fingers on the bony prominences of the baby’s hips. this will reduce the risk of injury to baby. Ensure that the umbilical cord is not handled as it may go into spasm

Question 10

What is lovsett’s manoeuvre?

Answer 10

a manoeuvre used to free the baby’s arms if trapped

Question 11

what manoeuvre is used if the baby’s head is not delivering?

Answer 11

Mauriceau-Smellie-Veit (MSV)

Question 12

After the birth of the legs, the baby needs to rotate to…?

Answer 12

Sacro anterior

Question 13

What are the 3 types of breech delivery?

Answer 13

1. spontaneous
2. assisted
3. breech extraction

Question 14

How to handle a spontaneous breech birth?

Answer 14

• either semi-recumbent or all fours position for birth depending on maternal preference and experience of attendant
• encourage active pushing once visible
• episiotomy should be used selectively
• spontaneous birth of limbs and trunk preferable
• legs may need to be released by applying pressure to the popliteal fossae (behind knees)

Question 15

Why would you take a HANDS OFF approach to a breech birth?

Answer 15

to minimise any damage to the baby and to make sure we dont complicate the birth any more than it might be

Question 16

what are possible complications of breech birth?

Answer 16

• failure to assist birth of after coming head
• head entrapment during pre-term breech birth
• nickel arms
• cord prolapse

Question 17

what are fetal risks?

Answer 17

• intrapartum death
• intracranial haemorrhage
• hypoxic ischaemic encephalopathy
• brachial plexus injury
• rupture of kidney, shoulder or hip
• rupture of neck, shoulder or hip
• fractured clavicle, humerus, femur
• cord prolapse

Question 18

when observing the descent of a breech, which position should baby be in?

Answer 18

sacro anterior

Question 19

what maternal position if preferable for a breech birth?

Answer 19

either semi-recumbent or all fours position for birth depending on maternal preference and experience of attendant